EFTA01583245.pdf

J.P. Morgan Derivatives Account Application and Agreement: J.P.Morgan Swaps and Other Contracts B. Personal Accounts Only (cont.) Name of Employer Name of Employer Occupation/Position Occupation/Position Address Phone Address Phone City State Zip City State. Zi Primary Account Owner Financial Information: Joint Account Owner Financial Information: Annual Income (5) Annual Income (5) Liquid Net Worth (5) LIqugl Net Worth ($) Total Net Worth Total Net Worth excluding primary residence (5) excluding primary residence (5) Spouse Information (If spouse is not the Joint account owner, please complete INS section.) Name Name of Employer Number of Dependents OCCupatIon/PoSitIon Annual Income (S) C. Entity and Trust/Estate Accounts Only Title of Account: SOUTHERN TRUST COMPANY, INC. Corporation 0 Partnership ❑ PiciPtic (applicable to International entitles only) OSole Proprietorship ❑ Limited Liability Company O Limited liability Partnership O Not for Profit O Trust O Revocable Trust O Living Trust ❑ Estate 0 Charitable Trust 0 Other The Dodd-Frank Act defines a 'special entity" as a federal, state or municipal agency, instrumentality, department or corporation of or established by the foregoing: an employee benefit plan or governmental plan subject to or as defined in the Employee Retirement Income Security Act of 1974, or an endowment (including an endowment that Is an organization descnbed in Section 501(c)(3) of the internal Revenue Code of 1986). The client al O Is nail a special entity within the meaning of the Dodd-Frank Act. If the client is a special entity, the client Is a: 0 Qualified Retirement Plan O Foundation C Endowment 0 Other Entity Name SOUTHERN TRUST COMPANY. INC. Address 6100 RED HOOK QUARTER, B3 oty ST. THOMAS state Vp 008021348 Phone Mobile Phone O ENS 0 SStIS Annual Income (5) 5,000,000.00 Liquid Net Worth (6)15,000,000.00 Total Net worth (f) 15,000,000.00 Legal Entity / CFTC Interim Compliant Identifier (entities and trusts only) 5 4 '9.3 0 0.A Z E I :L Mos,/ 14 11.8 1 . In order to facilitate the transaction reporting requirements of the Dodd-Frank Act, clients that are entities are required to obtain an identification number. currently called a CFTC Interim Compliant Identifier, or CICI, but which will be known as a Legal Entity Identifier (LEI) in the future. The CICI / LEI allows global regulators to monitor market activity and financial risk arising out of Derivatives. A client without a CICI or an LEI may contact its I.P. Morgan team for instructions on how to obtain one. Page 4 of 6 Confidential Treatment Requested by JPMorgan Chase JPM-SDNY-00062882 EFTA01583245